October 1st 2009

Viva Mama

Midwife gives antenatal care to an expectant mother.Midwife gives antenatal care to an expectant mother.

First published in the Huffington Post, September 22nd 2009

President Clinton was on Larry King the other night, reminding us with typical directness that people die simply because they can’t get medicine. This is particularly true for poor women and their newborn babies.

Women – mothers – are still dying in pregnancy and childbirth, all over the world, for want of cheap, standard medicines that we take for granted.

But today a new article is published in The Lancet that could transform the attitudes of donors and decision makers and potentially save millions of women’s lives.

Dr. Christina Pagel and Professor Anthony Costello of UCL model three different interventions for reducing the number of mothers’ deaths. One of these interventions – delivering medicines to mothers both in clinics and in the home – could potentially reduce mortality by as much as one third. A result coming anywhere close to such a reduction would be a breakthrough.

Richard Horton, the editor of the Lancet rightly notes that Dr. Pagel and Professor Costello’s proposal/model “has the potential to transform our attitudes to maternal health. We might now contemplate donor-funded drug-delivery programmes akin to those for HIV-AIDS and TB – in addition to health-facility strengthening.”

Of course it’s clear that the safest births take place in well-stocked facilities with trained health workers to care for mothers and their newborns. There are antibiotics for infection. Medicine to stop post-partum hemorrhage, and equipment for emergency care – including the ability to perform C-sections. Providing this for all mothers must be our long-term goal.

But in the meantime, something must be done – urgently.

Because whether we like it or not, over the next 10 years 400 million of the world’s poorest women will deliver their babies at home, often on mud floors, in modest huts. 10 million of these women will die unnecessarily, many from infection and hemorrhage – both of which are easily treated with affordable, standard medicines. As a result of their deaths children will die, families will suffer and go hungry, and communities will be impoverished.

How can these deaths be prevented?

The answer – as Clinton suggests – is increased access to cheap standard medicines. To this we would emphatically add training for an army of women health workers able to care for mothers and newborns in their homes and villages. As a bonus, this training will lay the foundations for a strengthened health system.

When we first looked at this challenge two years ago, we were reminded of our own history both in the UK and the US: that women stopped dying in childbirth in large numbers only when antibiotics came widely into use.

However when discussing women in poor countries we tend to forget this history. Instead we have convinced ourselves that in Africa and Asia the issues are too complicated to begin to address with straightforward Clinton-style approaches — or too complicated to invite the public to back a massive campaign (like AIDs campaigns for ARVs, or distributing bed nets for Malaria).

They’re not.

The public – particularly the immensely powerful constituency of women and mothers worldwide – would jump at the chance to be involved in such a campaign. But only if there is an effective, affordable solution to rally around, such as the bed net, antiretrovirals or vaccinations. Fortunately, thanks to Pagel and Costello we now have the findings to justify investing in such a solution and campaign.

It’s time to give mothers a break.

Viva Mama!


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